Midterm Flashcards
What are the four vital signs?
1- Body Temperature
2- Respiration Rate
3- Pulse
4- Blood Pressure
What is normal body temperature?
98.6 F
What are the four ways of measuring body temperature?
1- Oral
2- Axillary
3- Tympanic
4- Rectal
What is the least reliable way to measure body temperature?
Axillary
What is the most reliable way to measure body temperature?
rectal
What is the respiration rate for adults?
12-20 Breaths per minute
What is the respiration rate for children under the age of 10?
20-30 breaths per minute
What is the respiration rate for newborns?
30-60 breaths per minute
What is Tachypnea?
respiratory rates greater than 20 breaths per minute
What is bradypnea?
a decrease in respiratory rate
What is resting pulse rates in a normal adult?
60-100 beats per minute
What is the normal pulse for children under the age of 10?
Between 70-120 beats per minute
What is tachycardia?
a heart rate greater than 100 beats per minute
What is bradycardia?
slowness of the heart beat; by slowing of pulse rate to less than 60 beats per minute
What are the locations of a pulse?
1- Temporal
2- Carotid
3- Apical
4- Brachial
5- Radial
6- Femoral
7- Popliteal
8- Pedal
What is systolic pressure?
pressure exterted when the heart muscle is contracting
What is diastolic pressure?
pressure when the heart muscle is relaxing
What is normal blood pressure for an Adult systolic range?
100 to 140
What is normal blood pressure for adult diastolic range?
60 to 90
What are the factors that affect blood pressure?
1- Age
2- Gender
3- Blood Volume
4- Stress
5- Pain
6- Exercise
7- Weight
8- Race
9- Diet
10- Medications
11- Position
What is pharmacology?
the study of the interaction of chemicals with in living systems
What are the three ways to classify a drug?
1- Name
2- Action
3- Method of Legal Purchase
What are the drug classification by name?
Chemical Name
Generic Name
Brand Name
Drugs with similar chemical actions are grouped into categories called ______.
Drug Families
What are the two Legal drug classifications?
Prescription and Nonprescription
What are common drug dose forms?
Tablet, Capsule, Inhalant, Suppository, Solution, Suspension, & Transdermal Patch
What are classifications of drugs?
Analgesics, Antianxiety Agents, Antiarrhythmics, Antibiotics, Anticoagulants, Antidiabetic Agents, Antiemetics, Antiplatelets, Antiulcer Agents, Bronchodilators, Diuretics, Laxatives, Vasoconstrictors, Vasodilators
What is the two groups of analgesics?
opioid and nonopioids
What is an example of non-opioids?
Tylenol; Advil; Aleve
What is an example of opioids?
Morphine; Oxycodone
What is an example of an Antiaxiety Agent?
Diazepam (Valium); Lorazepam (Ativan); Benzodiazepines
What is an example of anticoagulants?
Herapin; Lovenox & Coumadin
What is the only treatment for Type I Diabetes?
Insulin
What are the treatments for Type II Diabetes
Insulin, Miconase, Glucotrol, Metformin, Januvia
What are the four basic factors that influence the movement of a drug?
1- Absorption
2- Distribution
3- Metabolism
4- Excretion
What is medical asepsis?
any practice that helps reduce the number and spread of microorganisms
What is surgical asepsis?
the complete removal of all microorganisms and their spores from the surface of any object on which they might exist
What are the methods of sterilization?
1- Steam under pressure
2- Gas
3- Chemicals
4- Dry Heat
5- Ionizing radiation
6- Microwaves/nonionizing radiation
What are the few basic principles of sterile technique?
- Sterile persons should avoid unsterile areas
- A sterile person touches only what is sterile
- Unsterile persons should not reach above or over the sterile field
-Hands covered with sterile gloves should be kept in sight and above waist level - A sterile person does not lean over an unsterile area
- A sterile person must remain within the sterile area. He does not lean on table or against the wall
What are the two methods of sterile gloving?
Closed Gloving Method & Open Gloved Method
How high should the IV bag be above the site of insertion?
18-24 inches
What is one of the most important things for the technologist do?
To gather information from the patient regarding his/her medical history
What is normal Creatinine level?
0.6-1.5 mg/dl
What is normal BUN level?
8-25 mg/dl
What are the four needle gauges and their colors?
18g - green
20g - pink
22g - blue
24g - yellow
What are the patient rights for drug administration?
RIGHT drug
RIGHT amount
RIGHT patient
RIGHT time
RIGHT route
How many times should you read the contrast label and when should you read it?
3; Before filling the syringe; Before administering the contrast media to the patient; Before discarding the vial or container
What should you do if the contrast infiltrates?
Stop the injection immediately and call the Radiology nurse and radiologist
How long does it take for a reaction to begin from contrast?
5-20 minutes
What are a few questions to ask the patient before administering contrast?
- Do you have any allergies to food or medicine?
- Can you eat shellfish and fish without any difficulty?
- Have you ever had asthma, hay fever, or hives?
- Have you ever been allergic to iodine?
- Have you ever had an IVP or CT injection?
- Have you ever had a reaction to an IVP or CT injection?
- Do you have now or have you ever had an cardiac problem?
- Have you ever had any kidney disease?
- Do you have both of your kidneys?
- Do you have multiple myeloma?
- Do you have diabetes?
- Are you a nursing mother?
- Are you currently taking medication to control angina, hypertension or irregular heart rhythm?
- Did you ever have a anaphylaxis to any medications or food?
What should you do if the contrast has a changed appearance?
Do not use it and report it
What should you do if you go into an R&F room and the contrast is already drawn up?
Get rid of it
Do you ever leave patient alone after contrast is administered?
NO
What are the five radiographic densities?
1- Air(Gas)
2- Fat
3- Water
4- Mineral
5- Metal
What is the purpose of a contrast study?
to visualize anatomic structures that are not normally seen on a diagnostic medical image
What are the two types of contrast media?
Negative & Positive
What is the difference between Negative & Positive contrast?
Negative- composed of low-atomic number elements (appears radiolucent/black on image)
Positive- composed of higher-atomic number elements (appears radiopaque/white on image)
Why is air not used more often as a contrast media?
low persistence (hard to control where it goes)
What patients are higher risk for contrast medium infiltrations?
- Patients who are unable to tell you there is a problem with the IV(e.g., children, elderly patients, and unconscious patients)
- Patients with impaired circulation to the extremity used for injection (e.g., stroke, diabetes mellitus, peripheral vascular disease, deep vein thrombosis)
- Patients who are receiving chemotherapy through IV access
What are signs and symptoms of IV contrast medium infiltration?
Signs: Redness, swelling, and/or tenderness at the IV site
Symptoms: Burning or tingling sensation during contrast medium injection
What is the treatment protocol for IV contrast medium infiltration?
1- Stop the contrast infusion at the first sign of infiltration
2- Elevate the extremity above the level of the heart
3- Notify the radiologist immediately
4- Attempt to aspirate any contrast from the tissue by using the IV access device
5- Apply dry ice packs or dry hot packs per radiologist
6- Massage tissue area to distribute contrast and allow it to be absorbed
7- Assess extremity for redness, skin blisters, or ulceration, firmness at the IV site, and a change in the temperature or sensation distal to the infiltration. Document the condition of the skin.
8- A plastic surgeon should be consulted for an infiltration greater then 30 cc.
9- For inpatients, the RN caring for the patient on the unit should be notified as well as the physician assigned to cover the patient. The infiltration should be documented in the chart as well as the treatment plans for the infiltrations.
10- An incident report must be completed to assist with Quality Improvement monitoring.
11- Outpatients should be monitored in the department per radiologist (usually 2-4 hours). Patients should receive hot and/or cold pack every 15 minutes intermittently. If the symptoms resolve, the patient may return home. The patient must receive written discharge instructions including a phone number to call in case of emergency. The radiology nurse must do a follow-up call that evening and 24 hours post-IV contrast medium infiltration.
What are the four ways to introduce contrast into the body?
- Ingestion; oral barium
- Retrograde; retrograde urography
- Intrathecal; myelogram
- Parenteral; intravenous
What are the four different forms of contrast? (radiopaque)
- Water soluble
- Pills
- Suspensions (barium)
- Oil based (ethidol & lipodal)
What is viscosity?
the thickness and consistency of contrast
What are the three categories of patient contrast reactions?
Mild
Moderate
Severe
What are signs and symptoms of a mild contrast reaction?
- Nausea
- Vomiting
- Cough
- Warm feeling
- Headache
- Dizziness
- Shaking
- Itching
- Strange taste in mouth
- Pallor
- Flushing chills
- Sweats
- Urticaria (hives)
- Nasal stuffiness
- Swelling about the eyes and face
- Anxiety
What are moderate signs and symptoms of contrast reaction?
- Tachycardia
- Bradycardia
- Hypertension
- Pronounced cutaneous reaction
- Hypotension
- Dyspnea
- Bronchospasm
- Wheezing
- Laryngeal edema
What are severe signs and symptoms of contrast reaction?
- Laryngeal edema
- Convulsions
- Profound hypotension
- Cardiac arrhythmias
- Unresponsiveness
- Cardiac Arrest
What are advantages of nonionic, LOCM?
- Lower osmolality
- No ionic breakdown and less toxic at cellular level
- More water soluble in blood pressure
- Warmed to increase viscosity
- Less likely to cause patient reaction
- More tolerable by patients
- High contrast effect resulting from number of iodine atoms per molecule
- Reduced injection volumes
What are anaphylactoid reactions?
- Urticaria
- Wheezing
- Throat swelling (edema)
- Bronchospasm
- Nausea
- Vomiting
- Cardiac Arrest
What are the four types of vital dye?
- Patent Blue V
- Evans Blue
- Brilliant Blue GFF
-Direct Sky Blue
What are lymphangiogram indications?
1- Assess the clinical extent of lymphoma
2- Staging of radiation treatment
3- Obstruction or other impairment of the lymphatic system
4- Locating nodes for biopsy or surgical removal
What are lymphangiogram contraindications?
1- Sensitivity to vital dye, contrast media or local anesthetic
2- Respiratory insufficiency
3- Concurrent radiation therapy to the lungs
What is the injection procedure for lymphangiogram?
1- Isolation of a lymph vessel for cannulation and injection requires a cut down procedure
2- The webbing between the toes is injected with .25 to .50 ml of the blue dye
3- The dye should visualize the lymphatic vessels with 15 minutes
4- The dorsum of the foot should be shaved, prepared and draped
5- The largest lymph vessel of the dorsum of the foot is located and the area around is anesthetized (First and second interdigital web space)
6- A longitudinal superficial incision is made on the dorsum of the foot to locate the dye filled lymphatic vessel.
7- The vessel is isolated by dissecting away the surrounding tissue
8- Two sutures are placed around the vessel
9- The lymphography needle is advanced bevel side up into the lumen
10- Normal saline is injected slowly, which dilates the vessel
11- The needle tubing is then attached to an injector pump and the injection is initiated. Oil contrast media is slowly injected into the vessel over a 30 to 45 minute period.
12- Radiographs of the foot and ankle area may be taken after about one minute of the injection time to ensure that the contrast media is a lymphatic vessel.
What kind of contrast is used for lymphangiogram?
oil based - ethiodol
What is the atomic number for barium?
56
What is the atomic number for Iodine?
53
What is the atomic number for negatives(air/gas)?
8
What are the routine images for a lymphangiogram? And when are they taken?
Routine Images
-lower extremities
-AP pelvis
-AP abdomen
-RPO/LPO abdomen
Taken within one hour of the contrast media injection and the second set 24 hours post injection
What are the complications of a lymphangiogram?
1- Contrast media reactions
2- Pain and possible vessel rupture (lymphatic muscle)
3- Pulmonary cerebral or hepatic emboli (very rare)
4- Infection at the injection site may occur if sterile technique is not maintained (not rare)
What are contraindications for a knee arthrogram?
Known to be allergic to an iodine based contrast medium or local anesthetics
What are indications for knee arthrogram?
Tears of the joint capsule, menisci or ligaments maybe caused by trauma; an example of a nontraumatic reason is a baker’s cyst
What equipment is needed for a knee arthrogram?
- R&F Room
- Digital images
- Cassette holder
- Arthrostress device
- Sterile Gloves
- Antiseptic Solution - Betadine
- Razor
- Emergency Equipment
- 2 to 3 inch wide ace bandage
- Arthrogram tray (sterile and disposable)
1-Prep sponges
2-Gauze sponges
3-Fenstrated drape
4-One 50 ml and two 10 ml
syringes
5-A flexible connector
6-Several Hypodermic
needles
7-5 ml ampule of local
anesthetic
Where is the injection site for a knee arthrogram?
Usually the medial aspect of the knee after the knee cap is dislocated laterally
What does an Arthrostress do?
It holds the leg in place for imaging
If a knee arthrogram is done dual contrast, what is used?
Both contrast and air
5ml of low density positive and 80 to 100 ml of a negative
What images are taken for a knee arthrogram?
AP and lateral; this should demonstrate the entire articular capsule by the combination of negative and positive contrast media
What does a shoulder arthrogram show?
Demonstrates the joint capsule, rotator cuff(formed by conjoined tendons of four major shoulder muscle), the long tendon of the biceps muscle and the articular cartilage
How is a shoulder arthrogram done?(contrast wise)
Single or Double
Single- 10 to 12ml of positive contrast (Omnipaque 300)
Double- 3 to 4ml of positive and 10 to 12ml of negative contrast
Which contrast study is believed to be the exam of choice for a shoulder arthrogram?
Double
What is needed for a shoulder arthrogram that is not used in a knee arthrogram?
a spinal needle
What are the routine radiographs for a shoulder arthrogram?
Suggested images are Scout AP projections, with internal and external rotations; and a glenoid fossa, transaxillary or intertubercular grooves projection
After contrast medium is injected the images are repeated
